Well I guess I just disagree. Using ketamine means starting a sedation
protocol. Means making a nurse take an hour or more out of her shift to get
pt ready, monitor and recover. It means filling out the sedation monitor
forms for me and her. TO the contrary giving midazolam is only anxiolysis
and does not invoke the same rules and regulations that moderate sedation
with K does.

I would rather forgo the LP than argue with parents as to whether their
child's crying should make me stop.

I guess I wonder if the child is awake enough to resist an LP enough to
scream and make moderate sedation necessary, how necessary is the LP?
How many times have you performed an LP that required sedation to find
meningitis or subarachnoid hemorrhage that was not seen on CT?

Thanks to all,
Medazolam is good to keep child sedated but there is the risk of paradoxical

excitation and decrease respiratory efforts after procedure.

ketamine has analgesic and amnesic effect.
Having no problem with doing the procedure doesn't mean the child and
parents are satisfied about it.
We had instance of parents refusing to continue the procedure because of
child's continous crying.
ketamine will be the drug of choice to keep everybody happy.

In Advanced PEM conference in NY last year there was a talk that argued
about the scientific basis of not using ketamine for head injury pt.